scholarly journals Comparison of Dosage Requirement of Erythropoietin Stimulating Agent (ESA) in Maintenance of Hemoglobin Concentration in patients undergoing twice weekly versus thrice weekly Hemodialysis in Pakistani Population

10.3823/2565 ◽  
2018 ◽  
Vol 11 ◽  
Author(s):  
Osama Kunwer Naveed ◽  
Marium Zafar ◽  
Sumbal Nasir Mahmood ◽  
Kunwer Naveed Mukhtar
Keyword(s):  
Iron Deficiency ◽  
Immunosuppressive Agents ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Left Ventricular ◽  
University Hospital ◽  
Average Dose ◽  
Dosage Requirement ◽  
Dialysis Vintage ◽  
Significant Difference

Anemia is one of the major complications of patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and is associated with left ventricular hypertrophy and also increases morbidity and mortality. Anemia in patients with CKD can be due to two major reasons; iron deficiency or erythropoietin insufficiency. Erythropoietin Stimulating Agent (ESAs) administration is the mainstay in treating anemia if the patient is iron sufficient. However, higher doses of ESAs have been associated with increased cerebrovascular and cardiovascular events. We conducted this study to see how much erythropoietin is required in our setting in iron sufficient patients to maintain hemoglobin(Hb)  level and the effect of dialysis frequency on ESA doses.  Methods and Findings: A cross-sectional study was conducted at the Department of Nephrology at Ziauddin University Hospital. Patients’ charts were reviewed for Hb levels and doses of ESA to maintain Hb between 10-12 mg/dl. Patients were excluded if they had iron deficiency, malignancy, were on immunosuppressive agents, had renal transplant, and with Hb >12 mg/dl or <10 mg/dl and their ferritin levels, transferrin saturation, hemoglobin concentration, frequency of hemodialysis and ESA dosage were monitored. We also compared these variables between patients undergoing hemodialysis thrice weekly with those undergoing hemodialysis twice a week. A total of 105 patients were analyzed. 24 were excluded as they did not match the inclusion criteria. 81 patients were included in the study. 36 (44.4%) were males and 45 (55.6%) were females. Mean age of the patient was 56.47 ± 11.72 years. The average dose of ESA was 106.91 ± 61.47 for patients undergoing hemodialysis thrice weekly and 183.94 ± 116.71 for patients undergoing hemodialysis twice a week. Significant difference was found to exist between dosage of patients undergoing thrice weekly dialysis versus twice weekly dialysis(p=<0.001).  Our study has limitations. First our study only looked at Hb levels, iron stores and dosages of ESA, while other factors like Parathyroid Hormone(PTH) levels and Vitamin B12 were not considered that may have a role in anemia of chronic renal disease. In addition, it was a study limited to one center only and a multicenter trial should be taken to validate the results. We have reported one aspect of dialysis vintage i.e.  high ESA dosage requirement Conclusion: We found that patients undergoing hemodialysis three times a week require recommended dosage of ESA; however those undergoing hemodialysis less than three times a week require higher dosage of ESA to maintain Hb level. Here we report significant effect of hemodialysis on ESA dosage to maintain same level of Hb. 

scholarly journals Iron deficiency and heart failure

2020 ◽  
Vol 26 (2) ◽  
pp. 59-71
Author(s):  
Mesut Rushid ◽  
Tatiana Chalakova ◽  
Lilyana Mircheva ◽  
Antoniya Kisheva ◽  
Yoto Yotov
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Transferrin Saturation ◽  
The Body ◽  
Diagnostic Methods ◽  
University Hospital ◽  
Iron Deficient ◽  
Significant Difference ◽  
Cardiology Clinic ◽  
Iron Deficit

Heart failure (HF) is a common and with poor prognosis disease that impairs quality of life. There are many causes of symptomatic worsening, but lately particular attention has been paid to iron deficiency and anemia as a cause. The reduced iron content in the body has turned to be a new important target for treatment in patients with HF. The aim of this study is to search for the prevalence of iron deficit in patients with HF hospitalized for exacerbation of existing or newly developed symptoms, and to establish its relationship with important prognostic parameters of patients. Patients and Methods: 209 consecutive patients with different etiology of HF were examined and hospitalized at the Cardiology Clinic of the University Hospital "St. Marina", Varna, at an average age of 68,89±12,06 (30-94 years), 58% of them male. Basic demographic variables, creatinine and eGFR were investigated, as well as an echocardiographic study, and a 6-minute walking test was performed. Iron deficit (ID) is formulated at ferritin values ​​<100 µg/l, or if values ​​are 100-300µg/l, then transferrin saturation should be <20%. An alternative method for determining ID was also used, correlating the two methods. Statistical methods include descriptive methods and Cohen&#39;s method of calculating the coefficient κ (Kappa) for determining agreement between two diagnostic methods. Results: There were 146 (70%) patients presenting with ID, with isolated deficiency without anemia occurring in 38% of patients. Anaemic syndrome is found in 87 (41.6%) of all patients, with 76% of anemia cases being iron deficient. Isolated ID is more common in women - 42 (48%) than in men - 38 (31%), p=0.014. There is no significant difference in age, EF, physical capacity, and glomerular filtration rate between patients with and without ID. The incidence of ID is similar in patients with different types of HF - with preserved, mid-range, or decreased EF. There is not a very good agreement between the different methods of determining ID, with coefficient κ=0.31. Conclusions: Iron deficit is common in patients with HF of various etiology and different forms, regardless of the presence of anemia. Females are more vulnerable to this disorder. Its significant presence and role in the prognosis and symptomatology of the patients require that patients be screened for ID and corrected consequently after its detection.

scholarly journals HEMATOLOGICAL CHARACTERIZATION OF BETA-THALASSEMIA IN SUDANESE PATIENTS

2020 ◽  
pp. 5-7
Author(s):  
RABAB HASSAN ELSHAIKH ◽  
SANAA ELFATIH HUSSEIN
Keyword(s):  
Iron Deficiency ◽  
Hemoglobin Concentration ◽  
Mean Value ◽  
Beta Thalassemia ◽  
Mean Corpuscular Hemoglobin ◽  
Corpuscular Hemoglobin ◽  
Significant Difference ◽  
Hematological Analysis ◽  
The Mean

Thalassemia is common inherited disorder among humans, and they represent a major public health problem in many areas of the world. The study aimed to the measurement of hematological characterization of beta-thalassemia in Sudanese patients. Blood samples from 61 beta-thalassemic patients were collected after written consent form obtained from all participants. The frequency of adults (>18 years) was 45 (73.8%) and children’s (<18 years) was 16 (26.2%); the frequency of male was 27 (44.3%) and 34 were female (55.7%). Hemoglobin estimation and red cell indices were carried out using the automatic blood cell counter Sysmex K × 21N. The results showed that Hb and RBCs indices were varied between mild to moderate and severe decreasing, hemoglobin concentration (Hb) with the mean value of 9.6 g/dL, with minimum value of 6.1 g/dl and maximum of 11.9 g/dl, while RBCs were increased in all patients, mean value 5.2 c/l, mean corpuscular volume mean was 58.9 fl, hematocrit was 30.4, mean corpuscular hemoglobin (MCH) 18.8 pg, mean corpuscular hemoglobin concentration (MCHC) was 31.7pg, and RDW was 18.8%. The method used for hemoglobin electrophoresis was capillary electrophoresis, Hb pattern shows increased HbA2 and HbF, the mean of HbA is 78.3%, HbF is 2.3%, and HbA2 is 6.5% with the min. value of 3.6% and max. of 12.2%. While the mean of serum iron was 82.75 μg/dl, 7 patients showed low level, 19 high level, and 35 were normal level. Comparison of hematological analysis (HbA2) in thalassemic patients coexisted with iron deficiency and without result was insignificant difference (p=0.645), this result disagrees with references that say iron deficiency masking HbA2. Nevertheless, the association between HbA2 and HbF revealed a statistically significant difference (p<0.013) and HbA2 with Hb was insignificant (p=0.260).

The Role of α-Thalassemia and Iron Deficiency in the Difference between Hemoglobin Levels of African-Americans (AA) and Whites.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3706-3706
Author(s):  
Ernest Beutler ◽  
Carol West
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Gene Frequency ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Iron Deficient ◽  
High Prevalence ◽  
Hardy Weinberg Equilibrium ◽  
The Difference

Abstract The fact that the average hemoglobin concentration (Hb) of AA is lower than that of whites has been documented extensively. Several investigations have shown that this difference of approximately 0.8 g/dL is due neither to iron deficiency nor to socioeconomic status. Its cause remains unknown. We compared the Hb of 1,493 AA and 31,029 white anonymized patients attending a Health Appraisal Clinic and confirmed the known difference in Hb, both for females and males (0.79 and 0.47 g/dL) respectively. The difference persisted when a subset of the subjects were paired by age and narrowed slightly in females when those with serum ferritin levels of <10 ng/ml or transferrin saturations of <16% were excluded (difference in females 0.59 g/dL; males 0.47). We determined the α-thalassemia −3.7 genotype of 298 AA. The gene frequency was found to be 0.17, and the distribution of genotypes fit the Hardy-Weinberg equilibrium. However, in a sample of 155 white subjects only one α-thalassemia allele was found (gene frequency=0.003). Among the AA subjects, the Hb and MCV values were lower in homozygotes (−a/−a) and heterozygotes (aa/−a) for α-thalassemia than in the aa/aa subjects. The table presents data for AA and white subjects after excluding all who did not have a documented serum ferritin level of >9 ng/ml and a transferrin saturation of >16%. Excluding subjects with sickle trait had no effect. Ethnic Group Genotype n Mean Hb SE Hb Mean MCV SE MCV −a/−a 3 11.87 0.418 72.23 2.32 F AA aa/−a 20 12.69 0.202 85.22 0.86 aa/aa 65 13.17 0.127 90.43 0.61 White 2917 13.60 0.016 90.85 0.07 −a/−a 2 13.85 0.550 83.05 1.65 M AA aa/−a 36 14.37 0.161 85.81 0.78 aa/aa 86 14.75 0.123 89.78 0.53 White 5335 15.09 0.013 90.35 0.06 As shown in the table, the average Hb of non-iron deficient AA females and males who had 4 normal α loci (aa/aa) was 0.43 and 0.34 g/dL lower respectively than those of whites, the difference being significant with p<0.01. We conclude that one cause of the lower Hb of AA compared to white subjects is the high prevalence of α-thalassemia in the AA population, but that it accounts for only about one-quarter of the difference after iron deficiency has been excluded. There are other, as yet undefined, causes that play a role. These may include the lower ATP (Biochem. Genet.1:25, 1967) and higher 2,3 BPG (Transfusion18:108, 1978) levels that have been documented in the red cells of AA subjects.

Serum Soluble Transferrin Receptor in Heterozygous β-Thalassaemia: Application in the Diagnosis of Iron Deficiency and as Hematologic Marker of Erythroid Activity According to Thalassaemic Genotypes (β0 vs β+).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3828-3828
Author(s):  
Jose Manuel Calvo-Villas ◽  
María Francisca Zapata ◽  
Ivan Alvarez ◽  
Silvia de la Iglesia ◽  
Jorge Cuesta ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Biochemical Parameters ◽  
Iron Status ◽  
Direct Sequencing ◽  
Saturation Index ◽  
Transferrin Saturation ◽  
Soluble Transferrin Receptor ◽  
Iron Deficient ◽  
Significant Difference

Abstract Although an increased level of serum soluble transferrin receptor (sTfR) have been found in both heterozygous β-thalassaemia patients with iron deficiency and in those with more severe genotype (β0), it is not a useful marker of iron deficiency status associated to β-thalassaemia. The aim of this study was to analyse the use of two biochemical parameters (sTfR and sTfR/log of ferritin ratio) to determine the iron status and to evaluate the degree of erythropoietic activity in a group of 221 β-thalassaemic heterozigotes patients (155 β0 and 66 β+). Serum ferritin and transferrin saturation index were measured in order to establish the iron status. Of the whole group, 51 patients were iron defficient (βthal-ID) while the remaining 170 were iron sufficient (βthal-IS). Based on the combination of β-thalassaemia genotype and iron status, patients were classified into four subgroups: β0thalassaemia and iron-sufficient (β0thal-IS) (n=124); β0thalassaemia and iron-deficient (β0thal-ID) (n=31); β+thalassaemia and iron-sufficient (β+thal-IS) (n=46); β+thalassaemia and iron-deficient (β+thal-ID) (n=20). 258 healthy and 56 iron-deficient individuals were used as controls. All the haematological parameters were measured by using analyzer Coulter® GEN-S™. Haemoglobins A2 (Hb A2) and F (HbF) were analysed by high performance liquid chromatography and molecular analysis was performed by real-time PCR and direct sequencing techniques. Chemical, inmunoturbidimetrical and nephelometric methods were used to measure iron status as well as sTfR. Comparison of haemalogical and biochemical parameters between subgroups was performed by using the t-student test and correlation analysis was calculated by using least-squares regression model. Mean sTfR level obtained was 2.63 ± 0.8 mg/dL and 2.57 ± 1.1 mg/dL in βthal-ID and βthal-IS patients respectively (p=0.783). Soluble transferrin receptor showed a positive correlation with HbA2, HbF and reticulocyte count values in βthal-IS patients (r=0.208 [p<0.05], r=0.440 [p<0.0001] and r=0.393 [p<0.00001] respectively) while it did not reach a significant correlation in βthal-ID patients. Mean sTfR/log sFt ratio was 2.75 ± 1.6 and 1.34 ± 0.5 in βthal-ID and βthal-IS patients (p<0.001). Interestingly, sTfR level was significantly higher in β0thal-IS patients when compared with β+thal-IS patients (2.76 ± 0.9 vs 1.42 ± 0.4) (p<0.001) as a result of an increased globin chains imbalance related to the β0 genotype. In the other hand, in the comparison between β0thal-ID and β+thal-ID subgroups neither sTfr level (2.71 ± 0.7 vs 2.40 ± 1.1) (p=0.417) nor sTfR/log sFt ratio (2.93 ± 1.7 vs 2.24 ± 1.3) (p=0.371) showed significant difference. In summary, sTfR/log sFt ratio is a valid parameter for diagnosis of iron deficiency associated to heterozygous β-thalassaemia. Unlike the findings observed in β-thalassaemic heterozigotes with normal iron status, sTfR level is not useful to evaluate the genotype severity in those with iron deficiency. Consequently, iron status should be determined before using sTfR as a parameter to provide a reliable estimation of the ineffective erythropoiesis related to the severity of β-thalassaemia genotypes.

scholarly journals Justification of Universal Iron Supplementation for Infants 6-12 months in Regions with a High Prevalence of Thalassemia

2021 ◽  
Author(s):  
Phakatip Sinlapamongkolkul ◽  
Pacharapan Surapolchai ◽  
Vip Viprakasit
Keyword(s):  
Iron Deficiency ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Iron Status ◽  
Transferrin Saturation ◽  
University Hospital ◽  
Deficiency Anemia ◽  
Increased Risk ◽  
Thalassemia Minor ◽  
Hb E

Abstract Background Many clinicians hesitate adopting a universal infant iron supplementation program due to the risk of increased iron absorption for those with thalassemia. We aimed to determine thalassemia prevalence in 6- to 12-month old infants, along with the iron status of those with and without thalassemia. Procedures: We performed a cross-sectional descriptive study of infants attending the Well Baby Clinic at Thammasat University Hospital for routine checkups. Complete blood count, hemoglobin electrophoresis, iron parameters, and molecular genetics for common α- and β-thalassemia were evaluated. Results Overall, 97 of 206 (47%) participants had thalassemia minor, the majority having Hb E traits. None had thalassemia intermedia or major. Familial history of anemia or thalassemia presented an increased risk of detecting thalassemia minor in offspring (OR 5.18; 95% CI 2.60-10.33, p = 0.001). There were no statistical differences in transferrin saturation, serum ferritin and hepcidin between iron-replete infants with thalassemia minor and those without. However, one-third of infants with thalassemia minor (31/97) also had iron deficiency anemia (IDA), with a similar risk of having iron deficiency to infants without thalassemia. There was no hepcidin suppression in our infants with thalassemia minor as compared to controls. Conclusions Both thalassemia and IDA are endemic to Southeast Asia. Infants with thalassemia minor, particularly with Hb E and α-thalassemia traits, are at risk of IDA. Our short-term universal iron supplementation program for 6 to 12-month old infants does not appear to increase the risk of those with thalassemia minor developing iron overload in the future.

scholarly journals Prevalence and associated risk factors of iron deficiency without anemia among school adolescents in Mbouda, Western Cameroon

2022 ◽  
Author(s):  
Odile Tadzong Mamokem ◽  
Wiliane Jean Takougoum Marbou ◽  
Marie Modestine Kana Sop ◽  
Bruno Phélix Telefo
Keyword(s):  
Risk Factors ◽  
Iron Deficiency ◽  
Serum Iron ◽  
Binding Capacity ◽  
Transferrin Saturation ◽  
School Site ◽  
Mean Values ◽  
Significant Difference ◽  
Associated Risk Factors ◽  
Iron Binding Capacity

Background: Adolescents are a particularly vulnerable age group to iron deficiency without anemia (IDWA). This study aimed at determining the prevalence and associated risks factors of IDWA among apparently healthy school teenagers in Mbouda, West-Cameroon.Methods: The 778 blood samples were randomly collected from adolescents aged 10-19 years of four schools in Mbouda. Appropriate indicators including haemoglobin and haematocrit, serum iron, ferritin, transferrin, and total iron binding capacity, transferrin saturation were determined using standard methods.Results: The overall prevalence of IDWA was 40.4%. High significant difference in the mean values of serum iron (p≤0.001), serum ferritin (p≤0.001), TIBC (p=0.007), CST (p≤0.001) were observed in participants with IDWA compared to those without IDWA. The sociodemographic risk factors of IDWA in school adolescents were school site (p=0.022; 0.14 (0.90-1.43) and period of menstruation (p=0.015; 1.48 (1.083-2.03). Consumption of roots-tubers [OR: 0.92 (0.48-1.77)] legumes [OR: 2.65 (1.91-3.67)], cereals [OR: 0.90 (0.67-1.22)], increased the risk of IDWA while consumption of vegetables [OR: 0.29 (0.22-0.39)], eggs [OR: 0.66 (0.49-0.90)], and fish-shrimp [OR: 0.172 (0.10-0.295)] decreased the risk of IDWA. Meal consumption frequency had a statistically significant association with IDWA (p≤0.001).Conclusions: This study identified that IDWA was a major public health in adolescents. This study will help in planning and implementation of the policy for prevention of IDWA in adolescents.

scholarly journals Difference in Antihypertensive Medication Pattern in the First Year Compared to More than a Year of Maintenance Hemodialysis: A Northern India Tertiary Care Experience

2022 ◽  
Author(s):  
Abhilash Chandra ◽  
Namrata Rao ◽  
Divya Srivastava ◽  
Prabhaker Mishra
Keyword(s):  
Antihypertensive Medication ◽  
Tertiary Care ◽  
Antihypertensive Agents ◽  
Blocking Agent ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Pill Burden ◽  
Cardiovascular Morbidity And Mortality ◽  
Dialysis Vintage ◽  
Significant Difference

Abstract Introduction There is a high prevalence of hypertension in maintenance hemodialysis patients. Information regarding prevalent pattern of antihypertensive medications will help modify it to prevent future cardiovascular morbidity and mortality. Materials and Methods In this cross-sectional study, patients on maintenance hemodialysis, aged ≥18 years visiting Nephrology outpatient department (OPD) from April 2019 to May 2020 were included. The patients were divided into two groups based on their dialysis vintage, ≤12 months and >12 months. Their antihypertensive medication patterns and two-dimensional (2D) echocardiography (ECHO) findings were compared. Independent t-test was used to compare continuous variables. One-way analysis of variance was used to study the antihypertensive drug-dosing pattern in both the groups. Results Out of 250 patients, 131 had a dialysis vintage of ≤12 months, whereas 119 had a vintage of >12 months. There was no significant difference in the number of antihypertensive agents used in either of the vintage groups. Calcium channel blockers (87.02 and 89.07%, respectively, in ≤12 and >12 months' vintage groups) and β blockers (64.12 and 65.54%, respectively, in ≤12 and >12 months' vintage groups) were the commonly used antihypertensive agents. Metoprolol use was higher in ≤12 months' group, whereas carvedilol usage was higher in >12 months' group (p = 0.028). Mean pill burden was more than five in both the groups. Concentric left ventricular hypertrophy was significantly more common in >12 months' group. Renin–angiotensin system (RAS) blocking agent use was limited to 3% of patients. Conclusion This study shows a high antihypertensive pill burden in dialysis patients likely due to underlying chronic volume overload in addition to the perceived efficacy of certain class of drug in a frequent dosing pattern. Low use of RAS blocking agent was also underlined. This study highlights the need to bring about changes in the antihypertensive prescription pattern in line with the existing evidence.

Abstract 13109: Oral and Intravenous Iron Therapy for Iron Deficiency Anemia After Cardiac Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Venturini Elio ◽  
Venturini Veronica ◽  
Francesco Giallauria
Keyword(s):  
Cardiac Surgery ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Aortic Surgery ◽  
Transferrin Saturation ◽  
Small Sample ◽  
Deficiency Anemia ◽  
Ferric Carboxymaltose ◽  
Low Grade ◽  
Significant Difference

Introduction: cardiac surgery is associated with a high risk to develop iron deficiency anemia (IDA) with impact on the Cardiac Rehabilitation (CR) program. Sucrosomial Iron (SI) is a new oral iron with good gastrointestinal compliance and bioavailability Hypothesis: to compare SI with Ferric Carboxymaltose (FCM) i.v. the gold standard treatment for IDA. Methods: 67 consecutive patients admitted to a CR unit after cardiac surgery (27 CABG, 29 valves/aortic surgery, 11 CABG+valves) were alternately treated with SI or FCM. Blood parameters were assessed at the admission (8-10 days after surgery) (T1), at discharge (18-22 days after surgery) (T2) and 10 days from discharge (T3). The study design provides for a single dose of 1000 mg of FCM at T1 or a dose of 120 mg of SI per day for the first 8-10 days after T1; then SI was scaled to 30 mg/die up to T3. Two groups were comparable in terms of age (SI vs FCM: 67.3 ± 12.8 vs 70.2 ± 12.2) and ejection fraction (SI vs FCM: 52.7% ± 7.8 vs 53.9% ± 5.4). Because the small sample size, non-normal distributed longitudinal variables were logarithmically transformed, to guarantee the maximum possible power to the analysis. Results: data are shown in the following table. At T1, two treatment groups showed no statistically significant difference. Hemoglobin significantly increased in both groups, without significant difference at T3. Transferrin saturation and Sideremia significantly increase in both groups, although the correction is faster with FCM. Ferritin, elevated to baseline for inflammatory condition after surgery, is reduced in the SI group, while it increases significantly in FCM group. Conclusions: SI is able to correct post-surgical IDA in times and ways comparable to i.v. FCM. The hyperferritinemia observed with FCM at T2 may be due to a low-grade pro-inflammatory effect correlated to the high level of iron deposition in macrophages. SI is able to recover IDA and to achieve normal Ferritin values, avoiding the risk of hyperferritinemia.

Reduced Hemoglobin Values in Children and Young Adults With Hemophilia

PEDIATRICS ◽  
1988 ◽  
Vol 81 (6) ◽  
pp. 840-845
Author(s):  
George R. Buchanan ◽  
Christine A. Holtkamp
Keyword(s):  
Young Adults ◽  
Iron Deficiency ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Occult Blood ◽  
Anemia Of Chronic Disease ◽  
Erythrocyte Protoporphyrin ◽  
Age Related ◽  
Children And Young Adults ◽  
The Mean

Mild leukopenia and thrombocytopenia are common in multitransfused hemophiliacs. Because little attention has previously been directed to measurements of erythropoiesis in these patients, we prospectively examined hemoglobin concentration and RBC indices in 94 children and young adults with hemophilia during comprehensive clinic visits. Additional studies performed in many included serum transferrin saturation, ferritin, haptoglobin, and free erythrocyte protoporphyrin measurements. Hemoglobin concentrations were recorded as age-related percentile values. Hemophiliacs of all ages and degrees of severity often had lower than average values for hemoglobin; 31% had values less than the third percentile, 46% less than the tenth percentile, and 83% less than the mean value. Reduced hemoglobin percentile values were unrelated to age, severity of disease, or human immunodeficiency virus antibody status. Only five patients had an obvious cause for anemia. Serum ferritin, transferrin saturation, and erythrocyte protoporphyrin values were usually normal, indicating that iron deficiency and anemia of chronic disease were uncommon. Although serum haptoglobin was reduced in 44% of the patients, reticulocyte count was infrequently increased. We conclude that hemoglobin values are frequently less than the mean normal values for age in hemophiliacs. Although frank anemia is common, it is usually mild and without obvious cause. Hemophiliac individuals with slightly reduced hemoglobin values probably do not routinely require detailed investigation for occult blood loss, iron deficiency, or inflammation.

P1647Prognostic significance of circulating leukocyte subtype counts in patients with chronic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Takae ◽  
E Yamamoto ◽  
F Oike ◽  
T Nishihara ◽  
K Fujisue ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Events ◽  
Hazard Analysis ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Monocyte Count ◽  
Ventricular Ejection Fraction ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Background Inflammation, characterized by early leukocyte recruitment, is known to be associated with vascular endothelial dysfunction and atherosclerosis. Previous studies have reported that an increased leukocyte count is a risk factor for the progression of atherosclerosis in cardiovascular diseases, and we previously reported that a high monocyte count was an independent and incremental of cardiovascular events in patients with coronary artery disease. Furthermore, previous study also reported that inflammation play a role in the pathophysiology of heart failure (HF), but few studies have evaluated the prognostic role of monocyte in patients with HF. Purpose To elucidate the prognostic value of monocyte in HF, we investigated the association of monocyte counts in patients with HF with their future cardiovascular events, and compared them among new categories of HF in this study. Methods Consecutive HF patients referred for hospitalization at Kumamoto University Hospital between 2006 and 2015 were registered. Finally, a total of 678 HF patients were enrolled in the study, and were followed prospectively until 2016 or until the occurrence of cardiovascular events. We defined high monocyte group as monocyte counts ≥360/mm3 according to previous clinical reports. We further divided HF patients into three types according to left ventricular ejection fraction (LVEF) (HF with reduced LVEF (HFrEF), HF with mid-range LVEF (HFmrEF), and HF with preserved LVEF (HFpEF)). Results In this study, HFrEF was 82 patients, HFmrEF was 118 patients and HFpEF was 478 patients, respectively. The average of total monocyte counts were 397±136 in HFrEF and 375±172 in HFmrEF, and 341±138 in HFpEF patients. Kaplan-Meier analysis revealed that both HFrEF and HFmrEF patients with high monocyte group (≥360 /mm3) had a significant higher risk of HF-related events (P=0.03 and P=0.02, respectively) but not of total cardiovascular events compared with those with low monocyte groups (<360/mm3) (P=0.001). By contrast, high and low monocyte groups in HFpEF patients had no significant difference in both total cardiovascular and HF-related events. Multivariate Cox hazard analysis identified a high monocyte count as an independent and significant predictor of future HF-related events in HFrEF and HFmrEF patients (hazard ratio: 3.02, 95% confidence interval: 1.20–7.59, p=0.018). Next, by whether they had ischemic heart disease (IHD), we divided HFrEF and HFmrEF patients into two groups. Non-ischemic HF group with high monocyte counts had a significant higher risk of HF-related events compared to those with low monocyte counts (P=0.014). By contrast, there was no statistically significant difference of the occurrences of future HF-related events between in ischemic HF group with high and low monocyte counts. Conclusion A high monocyte count was an independent and incremental predictor of HF-related events in HFrEF and HFmrEF especially with IHD, but not in HFpEF patients.

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